Wayne EasterParliamentary Secretary to Minister of Fisheries and Oceans

Mr. Speaker, when the member mentioned New Democrat I thought he really meant new. What we heard from the member for Acadie—Bathurst was similar to what we heard earlier from the member from B.C. It was rhetoric about the minister not going into the area.

I will have to establish those facts because the minister travelled extensively in the member's riding, meeting with fishermen, the Sea Coast Advisory Board, the Minister of Fisheries and Oceans for New Brunswick, the Maritime Fishermen's Union, the P.E.I. Fishermen's Association and the Nova Scotia fishing groups. He was down to the joint meetings on fisheries.

I would wager a guess that if the member does not know the minister was in the area maybe the minister has spent more time in Atlantic Canada trying to resolve the problems than the member has spent in his own riding, from the sound of things.

He talks about New Democrats. I would like to see them come up with new ideas and give us some proposals we could consider rather than the rhetoric they are throwing at us.

We moved on the EI issue to try to protect fishermen and the fishing communities, and we in fact have.

With regard to the motion today we on this side of the House have begun to bring forward a comprehensive national fisheries policy that demonstrates a real commitment to resource allocation and conservation. We have shown leadership on resource sharing with foreign interests. The turbot question is a prime example.

We are showing sensitivity to the individuals, families and communities that are affected. TAGS was an example. There were some problems but we were there when we were needed and we will continue to be there when we are needed in the future.

What new solution will the member propose rather than misrepresenting the real facts?

Mr. Speaker, I will reply to my colleague and I will use the same words he used earlier. When he is in the House, he should perhaps listen and stop preparing a second question without listening to what is being said.

What I said in my speech was that I invited the Liberal government to visit our community. First, I will set the record straight: I never said that the minister never came to New Brunswick. Second, what I said was that I invited the federal government to organize a forum in our community, to get the people in the industry together, and I made a suggestion to the effect that I want to get to the root of the problem and find a solution.

We will come back to the fact that they say they wanted to solve our problems. I will tell you something. People in my riding tried to escape the cycle of poverty because they could no longer work in the fish plants for a living. All they were told, according to the government's recommendations, was: “Go and work somewhere else. Go and make some wreaths or in other sectors”.

Do you know what the Liberal government did three years ago? It turned around and did a poor job. The Minister of Human Resources Development began checking into those who had received employment insurance. What did he do? He investigated 150 people. Now he is telling them: “Sorry, we made a mistake; now you owe us $20,000, now you owe us $25,000, because our department made a mistake and gave you employment insurance. We are sorry, but you poor folks who can hardly put bread on the table owe us Liberals $25,000. We want you poor people to give us $40,000”. That is what the Liberals have done.

Sorry, the vote will be held at the end of government orders for that day.

Before we begin the first private members' business hour of the 36th Parliament, the Chair would like to take a few moments to review with the House the rules governing the length of speeches during this segment of business.

As members know, on Friday, October 10, the House passed new Standing Order 95. This is the Standing Order that governs the length of speeches during the hour reserved for the consideration of private members' business.

The adoption of this new standing order results in the following: for votable items, the old rule remains unchanged from the last Parliament, that is, the member moving the item has up to 20 minutes and all other members up to 10 minutes.

For non-votable items, as is the case today for the motion standing in the name of the hon. member for Pontiac—Gatineau—Labelle, a different regime now applies. The member moving the item has up to 15 minutes and all other members up to 10 minutes.

After all members who wish to speak have spoken and provided there is still time remaining, the member moving the item may speak for up to five additional minutes. Copies of the revised Standing Order 95 are available at the table.

The House will now proceed to the consideration of private members' business as listed on today's Order Paper.

moved that Bill C-202, an act to amend the Canada health Act (nutrition services) be read the second time and referred to a committee.

Mr. Speaker, I am pleased to rise today to speak to Bill C-202, an act to amend the Canada Health Act. The bill is intended to amend the Canada Health Act by inserting the words “nutrition services”.

The Canada Health Act lists insured services, and nutrition services are not insured. We all know that dieticians and nutritionists are specialists in nutrition.

They promote the distribution and application of nutritional principles, advise on food choices and help prevent or treat the consequences of inadequate nutrition in people of all ages and groups from all communities.

They perform a professional function, whose aim is to promote health through healthy food choices. Their services are used in hospitals, sports centres, food markets, government and international agencies, medical clinics and educational institutions, to name but a few.

The public hears and reads a great deal about nutrition. The industry is constantly putting new products on the market or promoting particular ways of eating. Because of the difficulty to understand and interpret this information, people often turn to the dietitian nutritionist, someone who understands nutrition because of his or her university training in this science.

Dietitians and nutritionists in their concern to protect the public are worried about the quality of information disseminated about food and nutrition and want to warn people not to believe everything they read and hear.

Dietitians and nutritionists are experts in nutrition. All that is medically and nutritionally required falls within their field of specialization.

The reform of the health care system, the shift to ambulatory care and the subsequent redeployment of professionals increase the number of situations where the protection of the public and appropriate health care need to be improved and prioritized despite the economic climate.

Dietitians and nutritionists are in a good position to help people suffering from hunger. By linking their knowledge of foods with respect for others, they come up with creative ways of appeasing the hunger of thousands of people.

One of the places that comes to mind is the Dispensaire diététique de Montréal, which was established over 50 years ago and which has helped some 2,600 pregnant women in difficulty, a third of which were disadvantaged, and which established a model for effective dietary counselling in order to be able to answer society's greatest need: child poverty.

When children suffer from malnutrition, the first thing that springs to mind are health problems: anemia, underweight babies, delays in growth, deficiencies in nutritional elements such as calcium, iron, zinc and vitamins A and D, to name the main ones.

In addition, low birth weight is a risk factor in perinatal mortality and in physical and mental handicaps. It can also affect performance at school, reduced attention, fatigue and mood changes.

School programs also try to help young people from disadvantaged communities eat better. For example, milk has been provided in certain schools for over 20 years. Programs offering snacks, soup, low cost meals, food banks providing non-perishable items and nutritional education have been set up to help young people eat properly.

In another area, assessing needs, determining quantities and measuring effects on the organism are factors that must be taken into consideration in planning an expedition or athletic training.

For example, polar exploration requires very specific nutritional logistics. Everything has to be calculated. To ensure full nutritional value is obtained from prepared food and beverages, various factors must be taken into account: the explorer has to fight cold and wind, he will have long distances to travel, he will be carrying weight and the expedition may last a number of days, if not weeks.

This knowledge enables the dietitian or the nutritionist to be an invaluable partner in organizing such an adventure.

As mentioned earlier, dietitians and nutritionists are specialists in nutrition. They work to disseminate and apply nutritional principles, guide dietary choices and help prevent or treat the consequences of inadequate nutrition in groups of various milieu and individuals of all ages.

The dietitian's professional goal is to promote good health through proper nutrition. An ever-increasing number of individuals, businesses and organizations are utilizing the services of a dietitian. As members certainly know, the Canadian government recognizes them as a key resource in drawing up health policies such as Canada's food guide which provides guidelines for a healthy diet.

Historically the first nutrition programs were offered by the University of Toronto in 1902 and Toronto's Hospital for Sick Children was the first hospital to hire a professional dietitian in 1908.

In Canada there are two professional orders of dietitians: one in Ontario and one in Quebec. All the other provinces and territories have associations recognized by their respective provinces and territories. We must therefore conclude that the profession of these persons is recognized by their province but not by their country.

We will remember that, in 1992, at the international conference on nutrition in Rome, the participating countries, including Canada, supported a world declaration on nutrition and made a commitment to develop national nutrition strategies.

Health Canada set up a steering committee to prepare a national strategy on nutrition, and the committee presented its report providing strategies on nutrition for new directions in health in the spring of 1996.

The document on the subject of nutrition as a source of savings for the health and social services network issued in June 1997 by the Ordre professionnel des diététistes du Québec indicates that good nutrition is very cost effective and that it rapidly improves the health of those who are sick, cuts medication and the risk of complication, shortens the length of hospital stays and reduces the rate of return to hospitals and transfers to chronic care centres.

A look at the particular needs of the most vulnerable groups, including pregnant women and elderly persons, indicates that nutrition is indeed a source of significant saving for the health and social services network.

People aged 65 years and over have twice as many chronic health programs as those in all other groups in the population as a whole.

Chronic illness and physical disability combined with a reduced appetite seriously affect seniors' nutritional balance. The result, among others, is a greater risk of infection, dehydration and osteoporosis.

The effectiveness and efficiency of health care could be significantly improved through early nutritional examination of people at risk, through special nutritional intervention and a joint action by all decision-makers and interveners.

We should remember that the population aged 65 years and over has almost doubled in the past 30 years, and the proportion continues to grow.

Persons aged 65 years and over on the average have twice as many chronic health problems as the population as a whole. Reduced mobility often leads to difficulties in obtaining and preparing meals. A number of social factors also effect seniors' health, including loss of a spouse, retirement, isolation and insufficient income.

Because they eat less, seniors have a hard time meeting nutritional requirements for vitamins and minerals.

It is acknowledged that during chemotherapy and radiation treatments for cancer, multiple alimentary distresses can affect the individual's appetite and quality of life.

This is why good nutrition is essential to keeping the immunity system healthy. Malnutrition, even low level, may upset this immunity balance.

Of the people displaying malnutrition on leaving the hospital, 29% are rehospitalized unexpectedly within the three months of their leaving.

Appropriate nutritional action provides the most appropriate treatment of protein-caloric malnutrition in seniors preventing their return to hospital in the short term.

An American experiment, in which elderly persons were fed nutritional meals at home, shows that it is possible to reduce the number and the length of infections as well as the number of hospital stays and medical complications. It should be noted that the annual cost of this service amounted to the cost of a single day's hospitalization.

In another area, everyone has heard of osteoporosis, the deterioration of bone which may result in very severe fractures.

Osteoporosis patients must pay continued attention to the way they eat. Dietary intake of calcium and vitamin D is a decisive factor in prevention and treatment.

One can conclude that all of these physical difficulties, linked to a loss of appetite, can significantly affect the balanced diet of seniors, who can then become weaker and weaker. They become more vulnerable to infection, do not have the reserves to heal fast and therefore they need more health care services.

It is obvious, as many studies have indicated, that well adapted and timely nutrition services can help to limit the costs of health services, by reducing the number of days spent in hospital, prescriptions and medical examinations and by delaying or even avoiding admission to an institution.

Now, let us talk briefly about cardiovascular diseases, the main cause of death in Quebec. These insidious diseases develop throughout a period of at least 20 years and are linked to our lifestyles.

Risk factors on which we can have some kind of influence are hypercholesterolemia, high blood pressure, smoking and an inactive lifestyle. A single one of these factors doubles the risk of disease, two of these factors quadruple it and three multiply it by eight.

Strokes are the main causes of brain damage among adults. This alarming trend can be altered.

In 1995, the Massachusetts dietetic association released a study that showed that nutrition is the most effective and least expensive initial approach to the treatment of patients with low or moderate hypercholesterolemia.

According to another American study carried out in 1987 among patients with high blood pressure who were taking hypotensive drugs, in 50% to 69% of all cases, nutrition can replace hypotensive drugs during the first year of treatment.

In conclusion, my purpose today is not to convince members of the great value of the services provided by this group of professionals. We are all convinced of that value. In practice, however, this group whose national association has over 5,000 members, over 90% of them women, is not recognized by the Canada Health Act.

Madam Speaker, I appreciate the way in which the bill underscores the importance of nutrition services for Canadians. Studies have shown beyond any shadow of doubt that a proper diet is very crucial to the healing process. It also provides a needed preventive measure against illness.

Reformers and I are definitely in support of preventive and holistic measures. I endorse the way in which the bill constitutes a vote of confidence in Canada's dietitians who are skilled professionals and who serve the Canadian public well.

However I cannot support the bill for a few reasons. First, it is because I am not convinced and have not been convinced by the member's speech that it merely extends gracious recognition to dietitians. Rather it seems to put dietitians on a par with physicians as far as their ability to invoice the government directly is concerned.

It would appear that the bill will have the effect of creating a massive increase in expenditures due to the inclusion of nutrition services in the Canada Health Act. The summary of the bill shows us that the bill's purpose is to include nutrition services in the definition of insured health services. In fact they are already covered when a physician refers a patient to a dietitian.

It occurs to me that there has to be something more about the bill that I am not fully aware of to this point. If this is only about affirming health care providers, why not include physiotherapy, optometry, chiropractic services and all dentistry and not just surgical-dental services as the Canada Health Act now provides?

Given my concern I cannot support the bill because it fails to reckon with the economic forces at play in our country right now in relation to the budget. We have had a $7 billion shortfall from the Liberal government during the course of the last term in health and education. It fails to reckon with what is going on with medicare in our country at this time.

The Reform Party strongly supports the public funding of medicare as an essential, comprehensive, universally accessible national health service publicly funded and portable across the country.

Reformers also know that supporting such a program requires a great deal of funding. In order for that to happen across the country, the funding needs to be there. As I said before, funding of late has been insufficient to meet the needs of Canadians because of some of the cuts that have occurred over the course of the last number of years, expressly to the tune of some $7 billion for health and education.

We must be sober and acknowledge that the context of our debate today is a widely acknowledged crisis in health care funding. It is in this context that we need to ask a question. Can we afford to pay the additional costs that would be associated with adding nutritional services to the Canada Health Act? I would say that the answer at this point is no.

I also cannot support the bill because it further complicates an already existing strained, tense relationship at times between federal and provincial governments justifiably upset with being short-changed in respect to provincial health dollars.

Provincial health ministers are not waiting with bated breath for decrees from the House requiring additional expenditures. The provinces will simply not ask how high when Ottawa issues the command to jump. Nor will they ask how many when Ottawa issues the command to make bricks out of straw.

National standards will be meaningful and well received by the provinces only if they are backed by the funds needed to meet those standards, which is not currently the case.

A few quick phone calls I made this afternoon divulged to me another concern of mine, that there has not been a consultation process across the country. There has been no consultation with deputy ministers, health ministers and other key stakeholders.

It would be presumptuous for us in Ottawa to tell the provinces what their priorities in spending should be. There is no justification for fast tracking this through and giving it precedence over other health care services that are also interested in having more money to work with.

In some of the health districts in Saskatoon their concerns revolve around MRIs and keeping beds open since 70 beds will be closed in the Regina District Health for two weeks over Christmastime. Those people are more concerned about the shortfall of funding in those areas.

We have big concerns in other areas. Why would we add another area when there are big concerns and shortfalls in other areas that need to be shored up?

I recall a story from my province within the last couple of weeks of a 79 year old woman from Coronoch, Saskatchewan, who had to wait six days to have a hip pinned. Her life was endangered because of the policies of the government in terms of shortfall in funding. I am sure that she and her general practitioner would tell us that there is need for extra funding in other areas before we add more areas, which is the implication of the bill.

For these and other reasons that we do not have time to get into I oppose the bill as it stands. I would be open to further discussion in the future with the member opposite about the intent of the bill.

Madam Speaker, I am pleased to say a few words in support of Bill C-202, introduced by my colleague who is a physician and the hon. member for Pierrefonds—Dollard, and seconded by the hon. member for Pontiac—Gatineau—Labelle, whose riding is just beside mine.

The Bloc Quebecois has always been in favour of measures aimed at improving the health of the population. However, we always insisted on respecting the jurisdiction of Quebec and other Canadian provinces in the area of health.

Nutrition services can be of great help to Quebeckers and Canadians. Whether they work at the community level, in food services management, in education or in clinical practice, nutrition professionals help the population to better balance their food intake, hence their health in general.

In the present context of tremendous pressure due to budget cuts imposed by the Liberals since they came to power, it is clear that any measure aimed at improving the health of Quebeckers and Canadians can only be welcomed. When people are in better health—something good eating habits can only promote—they are less likely to become frequent users of health services; and this relieves pressure on the system and reduce costs in general.

That having been said, Bill C-202 is not without raising a few questions. The Canada Health Act, which would be amended by Bill C-202, sets out the conditions for the payment of the amounts provided under the 1977 Established Programs Financing Act, now part of the notorious Canada social transfer, for insured health services and related services.

As you know, the Bloc Quebecois has always taken a very firm and very clear position on health: the administration of health care is a provincial matter. It is necessary to be vigilant and ensure that a province that does not wish to comply with this measure or that wishes to introduce a similar service is compensated.

We must therefore be clear. Nutrition services cannot help but have a positive impact on the health of the general public. And if this is done with respect for the respective jurisdictions of each level of government, a point that has yet to be thrashed out, broadening access to nutrition services will help thousands of Quebeckers and Canadians to achieve a better lifestyle, better nutrition and, therefore, better health.

Madam Speaker, Canada's New Democratic Party supports the concept and believes the idea could be implemented with political will but without opening up the Canada Health Act.

Health care is about much more than hospitals and doctors. That is why the NDP has been standing in the House talking about issues like jobs, poverty, education for our young people and the social safety net.

About 1.4 million children live in poverty in Canada. Over 50% of aboriginal children both on and off reserve are living in poverty. The National Forum on Health says people who have been unemployed for any significant amount of time tend to die prematurely. That is why we continue to raise in the House daily the issues of employment and employment support programs like EI.

Canada's NDP has been a long time advocate for expanding medicare. We have been advocating for a national pharmacare program to include coverage of prescription drugs under the public insurance system. Liberal cuts to federal transfers for health have led many provinces to de-list drugs and impose increased user fees. These cuts hit poor Canadians and seniors hardest. A national pharmacare program would reverse this trend.

Unfortunately the Liberal promise on pharmacare rings hollow. We have had no assurances that Liberals intend to follow through on their election rhetoric.

Canada's NDP has also advocated change in the area of home care. A national home care program would encourage innovation in the area of health care and help provinces deal with the changing roles of hospitals and doctors. The huge burden placed on women in the home, the ones who are primarily left to care for patients, would be reduced.

Canada's NDP will continue to fight for better health care. We will fight to stop the $1.2 billion cut in federal Liberal health transfers this year. We will fight for programs to relieve poverty and for jobs.

We appreciate the spirit of this motion. This House can rest assured that Canada's NDP will be there fighting for better health care for Canadians, for pharmacare and for home care.

I think it is important to take a look at what is happening in health care. Our situation in New Brunswick is very critical, and I think it is very important to talk about it, because every day New Brunswick's newspapers carry articles about our seniors in nursing homes. Because of the Liberals' cuts to the provinces, these are no place for our seniors.

My mother would not go into one of these homes, that is for sure. There are some frightening stories in New Brunswick today; there are a number of investigations taking place into health care in the province. Why? There are two reasons: health care cuts, and cuts in provincial transfer payments. In addition, our provincial Liberal government would rather put money elsewhere than in health care.

I was also very surprised at the comments by the Liberal member when he said he was concerned about health care for women. I would like to see him just as concerned about the problem of pay equity for women

Madam Speaker, I rise to speak on this private member's Bill C-202, an act to amend the Canada Health Act. I compliment my colleagues for the initiative.

However, I want to address today the difficulty of reconciling the proposed amendment with the fundamental purpose and the intent of the Canada Health Act.

Let me say at the outset that I, and I think all other members of my party, are sympathetic to the concerns raised in the bill. Although the promotion of better nutrition is important, unfortunately the Canada Health Act, in my opinion, is the wrong instrument to achieve this objective. I hope to illustrate that over the course of this intervention.

The Canada Health Act sets out the broad principles under which provincial plans are expected to operate. The act establishes certain criteria that provincial plans must meet in order to qualify for their full share of the federal health care transfer payments. Federal transfer payments may be reduced or withheld if a province does not meet the criteria and the conditions of the act.

These critera are the cornerstones of Canada's health care system. They are: reasonable access to medically required services, unimpeded by charges at point of service or other barriers; second, comprehensive coverage for medically required services; third, universality of insured coverage for all provincial residents on equal terms and conditions; fourth, portability of benefits within Canada and abroad; and finally, public administration of the health insurance plan on a non-profit basis.

In addition to the above criteria, the conditions of the act require that the provinces provide information as required by the federal minister and that they also give appropriate recognition to federal contributions toward health care services in order to qualify for federal cash contributions.

The act also discourages the application of extra billing or user charges through the automatic dollar for dollar reductions or withholding of federal cash contributions to a province or territory which permits such direct charges to patients. In fact, the threat that user charges and extra billing would erode accessibility to needed medical care was a major impetus in the development of the act.

The Canada Health Act was enacted to protect the fundamental principles of our publicly financed, comprehensive, portable, universally accessible health insurance system. I think everybody in this House would agree that these are laudable objections.

Our system of national health insurance, or medicare, as it is popularly known, is close to the hearts of Canadians and something too precious to tamper with for no valid reason.

Canadians support the five principles and feel that medicare is a defining feature of Canada. Time and time again, polls demonstrate high public support for medicare.

The amendments presented by my hon. colleague and friend, if adopted, would affect the definition of insured services under the act.

In short, this means that if Bill C-202 is passed by this House the provinces and territories would be required to provide on an insured basis to all of their residents nutrition services. This is not the purpose of the Canada Health Act.

The purpose of the Canada Health Act is to ensure that Canadians have access to medically necessary hospital and physician services without financial or other impediments. Moreover, Canada Health Act principles deal with the organization and delivery of health care services on the level of provincial and territorial plans.

The addition of nutrition services to section 2 of the act would be intrusive and interfere with the provincial-territorial responsibility for health services management.

Clearly the Canada Health Act is not the proper place to regulate matters such as nutrition services which properly fall under provincial jurisdiction and are better handled at this level. Even if the Canada Health Act were the appropriate place for such a provision it would probably not achieve its objective.

The act places conditions on payments to the provinces and territories and can reduce or withhold transfers if these are not met. It cannot dictate to a province or territory how to run its health care plan much less its institutions.

The federal government recognizes that provinces and territories have the primary responsibility for the organization and delivery of health care services and that they require sufficient flexibility to operate and administer their health care insurance plans in accordance with their specific needs and institutions.

This is why the flexibility inherent in the Canada Health Act has always been one of its strengths. Since the enactment of the Act in 1984, the federal government has always attempted to work with the provinces in order to make the act a viable piece of legislation. It could be dangerous to tamper with the provisions of the Act when they have received such wholehearted support.

If we want medicare to survive, we must be vigilant against blatant threats such as user charges.

I want to come back to the point that while nutrition is a serious concern the Canada Health Act is not the appropriate place in which to address this issue. As it stands now the Canada Health Act does not require that the services of nutritionists be provided on an insured basis. It does not forbid provinces and territories from providing coverage for these services as well.

For the federal government the decision to provide nutrition services as part of a package of insured health services should be left to the provinces and to the territories. This does not mean that the federal government has no interest in the nutrition issue. Quite the contrary. The federal Department of Health has always been involved in the promotion of good nutrition in Canada.

In 1992 Health Canada released Canada's food guide to healthy eating. The guide provides Canadians with information on establishing healthy eating patterns through the daily selection of foods. To date, and this will be of interest to colleagues in the House, over 21 million copies of the guide materials have been distributed. That means that every man, woman and child capable of reading in this country has a copy in his or her possession potentially.

The food guide then is currently serving as the basis for a wide variety of nutrition initiatives across Canada implemented by a broad range of partners including provincial, territorial and municipal governments as well as non-governmental organizations, consumer groups, the private sector and school boards.

The most recent national population health survey shows that more and more Canadians are taking steps to improve the quality of their nutrition. This is encouraging. I believe that it is important that we continue to support the efforts that promote the importance of good nutrition.

The proposal put forward by my hon. colleague and friend is very commendable.

However, it is in my opinion problematic in that it raises the problems I have outlined. That is why I cannot support the bill, regrettably.

Normally I would speak for much longer, but I see that my colleague wants to address the issue even further. Therefore I will relinquish my position now.

Madam Speaker, I also rise to speak on the subject of private member's Bill C-202, an act to amend the Canada Health Act.

Given the respective roles and responsibilities of the federal and provincial territorial governments in the area of health care, I believe that amending the Canada Health Act may not be the best approach to address the concern of our hon. colleague.

As you are already aware, under the Canadian Constitution, the responsibility for health care lies with the provinces and territories. In other words, the provinces and territories are responsible for administering and delivering the health care that is available to Canadians.

This means that the provinces and the territories act as planners, managers and administrators of their own health care systems. In practical terms, this includes negotiation of budgets with hospitals, approval of capital plans and negotiation of fee agreements with medical associations.

The federal government, for its part by law, is responsible for the promotion and preservation of the health of all Canadians. Health Canada is responsible for bringing together parties on health issues of national and interprovincial concern.

The federal government also assumes the responsibility for setting national policies and for providing health care services to specific groups such as treaty Indians as well as Inuit. It is appropriate when describing federal responsibilities in health care to note what the federal government cannot do.

It cannot interfere in provincial territorial responsibilities as defined under our Constitution, nor can it be seen to be infringing on these responsibilities.

Bill C-202 attempts to require provinces and territories to provide nutrition service on an insured basis. As it is the provinces and territories that are responsible for matters dealing with the delivery of health services, to require that nutrition services be added to the list of insured health services would be perceived as an unacceptable intrusion on the provincial territorial responsibilities under our Constitution.

The federal government cannot and should not act unilaterally in an area of provincial jurisdiction. Any decision to extend the scope of the Canada Health Act requires extensive consultation and support from the provinces.

In 1984 concerns over hospital user fees and extra billing by physicians led to the passage of the Canada Health Act. This was achieved with all-party support. The federal government's aim in passing the Canada Health Act was to reaffirm its commitment to the original guiding principles expressed in the earlier legislation.

It was also to provide a mechanism to promote the provinces' and territories' compliance with the act's criteria, conditions and extra billing and user charge provisions.

In short, the purpose of the Canada Health Act is to allow Canadians reasonable access to necessary prepaid health services.

The provinces and territories have retained the responsibility of administering their health insurance plans under the Canada Health Act and for managing their respective systems. The management of health care personnel and related issues, such as the one proposed in Bill C-202, is also their responsibility.

The criteria of the Canada Health Act are known to most Canadians and regarded as the defining principles of medicare. The principles of public administration, comprehensiveness, universality, portability and accessibility are valued and cherished by Canadians who will not accept changes to them.

Poll after poll indicates great public support for these national principles. Even while discussions of health care reform are taking place, the values which are reflected in each of these principles are not being debated.

Provincial and territorial ministers of health share this support. We know that Canada's health care system needs to be modernized to ensure that all Canadians continue to have access to needed health services. This is of particular importance as delivery methods, as well as venues, change over time. However, governments at all levels have articulated their support for the five principles of the Canada Health Act.

Regardless of the reforms currently taking place, the principles of the Canada Health Act remain the cornerstone of our health care system.

I would like to reiterate that the provinces and territories may, at their discretion, provide insured services other than those covered by the Canada Health Act. Nutrition services may be offered as complementary health services.

Although the objectives of Bill C-202 have merit, to pass this bill would disrupt the historical distinction and balance between federal and provincial jurisdiction. It would infringe on the longstanding federal and provincial territorial relationship that has facilitated the creation of a health care system that is widely cherished by the Canadian public.

For this reason, although I recognize the value of nutritionists across Canada, this bill cannot be supported by the federal government.